Gestational diabetes mellitus associated with subclinical hypothyroidism. Maternal and perinatal outcomes

• Lemin M. Leffad
• Nadezhda M. Startseva
• Said M. Semyatov
• Andrey S. Anikeev
• Mariya I. Sviridova
• Valeriya A. Kovaleva
• Тatyana A. Startseva

Abstract

The aim of the study was to evaluate maternal and perinatal complications in patients with gestational diabetes mellitus (GDM) associated with subclinical hypothyroidism (SHT).

Material and methods. A retrospective cohort study included 338 patients: 53 with GDM, 160 with SHT, 125 with GDM+SHT, who were observed and delivered at the Perinatal Center of the City Clinical Hospital # 29 named after N.E. Bauman in 2022. The data were obtained by analyzing the birth histories, including anamnesis, term and method of delivery of patients, their body mass index, the presence of the following pregnancy complications: anemia, preeclampsia (PE); in newborns – birth weight, Apgar score, the need for resuscitation, the presence of signs of diabetic fetopathy (DF).

Results. All three groups were comparable in age. In all groups, there was a high incidence of impaired fat metabolism (85; 68.3; 67.2%), with a significant predominance in the group of patients with GDM [p(GDM – GDM+SHT)=0.0171; p(GDM–SHT)=0,216]. The following complications of pregnancy and childbirth were identified by groups: GDM, SHT and GDM+SHT, respectively: PE (7.5; 25; 10.5%), anemia (32.1; 50.6; 61.3%), macrosomia (24.5; 7.5; 17.7%), DF (9.3; 0; 15.5%), abdominal delivery (13.2; 20; 37.1%). The body weight of newborns was higher in the GDM+SHT group compared to the SHT group (3676.72±268.71 p=0.0062). The combination of GDM and SHT significantly increased the chances of anemia (RR=1.926, 95% CI 1.271–2.919; OR=3.285, 95% CI 1.665–6.48). The presence of SHT in patients with GDM increased the frequency of operative delivery (RR=4.876, 95% CI 1.849–12.861; OR=7.133, 95% CI 2.417–21.048). It is noteworthy that abdominal delivery was performed more often in the group of patients with SHT than in the GDM group (13.2 vs 20%). The average values of the newborn’s Apgar score at 1 and 5 minutes were significantly lower in the SHT group compared to the GDM group [(p(1’)=0.0006; p(5’)=0.0001] and also significantly lower in the GDM+SHT group compared to the SHT group [p(1’)= 0.0022; p(5’)=0.0037].

Conclusion. The results obtained confirmed the implementation of BMI in the development of endocrine diseases during pregnancy. The degree of obesity was more pronounced in patients with the presence of SHT. The combination of GDM and SHT worsened the course of the gestational process and determined the method of delivery: anemic syndrome was more often detected, the frequency of CS increased. The comorbidity of SHT and GDM did not affect the frequency of macrosomia, DF and the need for intensive neonatal care, however, it reduced the newborns Apgar score. Considering TSH not only as an indicator of SHT, but also as a predictor of GDM, timely prevention and diagnosis of GDM becomes possible. Further studies are needed to assess maternal and perinatal outcomes, depending on the timing of diagnosis and the degree of SHT compensation.

Keywords:gestational diabetes mellitus; subclinical hypothyroidism; maternal and perinatal risk factors; comorbidity

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